Healthcare Provider Details

I. General information

NPI: 1114344207
Provider Name (Legal Business Name): PRERANA AGHAMKAR WILLIAMSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRERANA AGHAMKAR

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-3818
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-4500
  • Fax: 336-713-4501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number2020-01643
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: